Healthcare Provider Details

I. General information

NPI: 1598801441
Provider Name (Legal Business Name): DONALD G. HOVANCSEK DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 MARTIN WAY E
OLYMPIA WA
98506-4946
US

IV. Provider business mailing address

PO BOX 3220
LACEY WA
98509-3220
US

V. Phone/Fax

Practice location:
  • Phone: 360-943-9600
  • Fax: 360-943-9694
Mailing address:
  • Phone: 360-943-9600
  • Fax: 360-943-9694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO00000155
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: